Hendrickson Insurance · Sarasota, Florida

Office & professional services application.

Business owners policy, general liability, and professional liability (E&O) for Gulf Coast offices and professional firms — Sarasota, Bradenton, Tampa, and St. Petersburg. Law, accounting, consulting, real estate, tech, and medical offices all price off your profession, your revenue, and your contracts, so tell us how you actually work. Estimates are fine where you are not sure.

A. Business & Contact

Legal / named insured (business name) *

Required.

DBA (if any)

Contact name *

Required.

Office address

City

State

ZIP

Business phone *

Required.

Email *

Enter a valid email.

Entity type

Years in business

B. Profession & Staff

Profession *

Required.

Describe the services you provide

# of licensed professionals

# of support / admin staff

Annual revenue

C. Clients & Contracts

Largest single client as % of revenue

Do you work with clients outside Florida?

D. Office & Property

Own or lease the office?

Square footage

Business personal property (contents)

Building value (if owned)

E. Professional Liability (E&O)

Skip this section if you do not need professional liability / errors & omissions.

Do you carry E&O now?

Current E&O limit

Current E&O carrier

Retroactive date (if known)

F. Coverage Wanted & Current Insurance

Check what you want quoted

Business owners policy (BOP) General liability Professional liability / E&O Cyber liability Workers compensation Directors & officers Umbrella / excess Not sure, advise me

Current carrier (if any)

Current policy expires

G. Loss History

List date, type, and amount for each

H. Acknowledgement

I certify the information above is true and complete to the best of my knowledge. Submitting this form does not bind coverage; coverage is subject to underwriting approval and payment of premium.

Typed signature (full name) *

Required.

Date *

Required.

I agree to the statement above. *

Please confirm to submit.

Back

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Thank you — application received

Dennis will review it and follow up shortly with your quote. Questions? Call or text 941-952-7991.

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